Creating a new Pharmacy service system in the Indian Healthcare system.

From,

Bhagwan P. S, B. Pharma, Frmr. Registrar, KSPC, Frmr. Dy Director (PHARMACY), HFW dept, Govt. Of Karnataka. 

• To

• The Secretary, 

• PCI, 

• Dear Archana. Mudagal ji, 

• Greetings & Good wishes. 

• Sub: Creating a Pharmacy service system in the Indian Healthcare system. 

• Well madam, as you are aware that an organized pharmacy service system does not exist in Indian healthcare system and as such pharmacists with different qualification, specialization and capabilities are deprived of an opportunity to serve in the healthcare sector.

• Needless to say the notifications you as Secretary PCI issuing from time to time including the ppr 2015 and it’s latest amendment hardly provides any clue or a clear roadmap for the policy makers and Bureaucrats  to consider or discuss. 

• Govt being the largest healthcare service provider in India needs to be apprised from all angles (1) structural, (2) functional with (3) financial implications. But we from PCI can provide the (1) and (2) leaving the (3) to the Government to decide. 

• Hence, with my experience and knowledge gained in Govt service I submitting to you a draft proposal to uplift the Indian healthcare system that needs and provides a comprehensive #Pharmacare support service for onward submission to the Govt of India. 

•# PharmaCare – A concept to upgrade Indian Healthcare System, 

👉Introduction

• Indian Healthcare system is a very huge and complex service system catering to ……. millions of people in India. The system involoves a massive preventive sector and an equally large curative sector. Considering the dictum that ‘The Medical care begins the moment the Healthcare fails’ the Govt of India is spending very heavily on the preventive sector to ensure the medical care is minimized as much as possible.

• Though the system to address the healthcare and medical care is in place there are some serious lacunae that are causing serious deficiencies in the servive that are just ignored or accepted on default but seldom assessed and openly admitted due to some obvious reasons.

• What the public are seeing and appreciating is glamorous looks and some relief they are getting with no knowledge of hidden threats of loaded molecules the consequences of which are just accepted to ignore or go in for one more round of treatment either as a new problem or an accepted ongoing exercise. 

• Indian medical practice is being very very poor in documentation it is humanly impossible to trace back and investigate to find out the trouble shooting black spot. So to say, the Indian medical practice is far behind #Evidence Based Therapy.

• Amidst the massive drugs movement that is happening the cry due to  scarcity of the vital drugs at the terminal service point and financial burden due to illogical vendor driven procurement  and the consequence wastage and demand for more and more funds is an equally a massive challenge.

• But, knowingly the Indian Healthcare system is continuing the weak traditional system and deliberately avoiding the solution that warrants professional management with Logistic Pharmacists and Clinical pharmacists.

• Situation analysis

• In India, we have a National Drug Policy which is industry oriented but not Healthcare oriented and we do not have a ‘National Medication Policy’ to ensure rationale and evidence-based medication. The National Health Policy document published annually seldom touches this problem and the need.

• Hence it is necessary for each healthcare professional and institution to be on their own guard, by study of literatures and maintaining their own clinical reports of drugs they use and monitor the compliance, results and Adverse Drug Events.

• ‘Pharmacovigilance’ is a figment of Clinical Pharmacy and is a  routine duty of the Clinical Pharmacist and to a lesser extent of the logistic pharmacist also including retail pharmacist. Somehow making it a National vertical program under CDSCO  is not convincing. 

• As per the data from AIOCD AWACS more than 3000 products are launched in India every year.  It is humanly impossible for any Clinician to understand and digest the intricacies of these new molecules. Formulations along with hundreds of ‘Me-too’ formulations let alone remembering their therapeutic indications, worthiness, possible toxicities, contraindications, incompatibilities etc.

• The irony is the clinicians prescribe the formulations that they never have seen but with the information they received.

👉 Drug Quality 

• Everybody wants Good medicine. What is good medicine? 1. The one that gives good relief, the one with least side or after effect/d, the one that is safe, the one is affordable and effective with least side or after effect. Law says a Good medicine is one that passes the tests of standard which is only a In-Vitro parameter. Clinical satisfaction and patients satisfaction is a variable factor though is important.

• It is true that drugs and formulations under go quality check while during process and also before being released into the market. That means each batch is as per standardized well tested and established procedure. 

• Unfortunately, the fact is:

• “What is tested is not available for use and what is available for use is a presumptive quality”. 

• Nothing wrong and it is inevitable but warrants only an additional care to keep evaluating at Clinical level too with due documentation of observations, experience and feedback on its affordability, acceptability, patients comfort, clinical or therapeutic response, Adverse events etc . But, these aspects of  therapy are observed and  experienced only in the clinic. 

• Clinicians changing their own prescription for unknown reason to a different make of a same molecule or formulation are almost an everyday happening at the cost of the patient. This is going on undocumented and nobody dares to question?. The Therapeutic quality assessment though variable from one Clinician to the other and one clinic to the other can also be standardized near to reliable accuracy through documentation which forms the backbone of pharmacare service. This documentation particularly at thr institutional level can for a part of the evaluation of tender while fixing Contract.

• This warrants an in-house comprehensive ‘Pharmacare’ department to carry out in-house evaluation of all the medication related issues so that what reaches the Clinician and the patient at least in and from an institution would be of a well-studied and clinically evaluated formulation. That ensures evidence-based medication therapy. 

• Clinicians are so hard pressed for time and the patient load being so heavy. It doesn’t allow any comfortable free time for them to do library and literature research to keep themselves abreast with the trend and true picture of the products they are using. They need an in-house reliable dedicated facility to study the medicines they use and appraise them regularly in the best interest of the patients.

• This situation warrants a need for a professional service system that could be called “PharmaCare” system that addresses all challenges cited above professionally to support the Healthcare preventive and curative institutions to ensure Professional Drugs logistic system obviating scarcity and loss on one hand & Evidence based therapy and better patient compliance to support the Clinicians.

•👉 Objectives of Pharmacare service

• To achieve:

• Economy with reliable drugs logistics

• Zero Prescription and  medication error

• Zero defect in the drugs delivered

• Improved patient compliance

• Reduced morbidity rate

• Patient’s records that can match with logistic records 

• Streams of Pharmacare service

• Drug Logistics Management (DLM) headed by a Chief Drugs Logistic Pharmacist

• Supportive Clinical Pharmacy Service (SCPS) headed by a Chief Clinical Pharmacist

• 👉Broadly here is how they would be functioning:

• Drug Logistics management (DLM) • Supportive Clinical Pharmacy Service (SCPS)

• Preparation of drugs list with full specification and coding.

• Preparation of Essential list of drugs and quantification

• Budgeting to put forth rational demand

• Defining the stocks for procurement

• Rationale budget management

• Expenditure planning with the available budget

• Defining procurement policy

• Rational inventory management as per priority classification

• Distribution management

• Qualitative dispensing

• Standard Operating Procedure

• total quality management • Preparation of STG, EDL, Formulary

• Supportive service to clinician

• Patient counseling and assistance

• Pharmacovigilance program

• ADR monitoring, reporting and evaluation

• Drug efficacy evaluation in vivo – to eliminate ineffective drugs from the hospital formulary and stocks

• Study of product literatures and technical  interaction with Pharma representatives

• Develop standard facility and SOP as per the Act & Rules  for clinical trials with due safeguards for the volunteers 

• Total quality management

• 👉Benefits to Clinicians

• Hassle-free supply of reliable approved drugs & formulations  

• Lessened brain burden on Clinicians as clinical pharmacist would be supporting with case specific drug information 

• Pin pointed prescription and minimized ADRs

• Counseling service by clinical pharmacists to each patient on medication regimen

• Separate patient’s medication record– helps in follow up and in avoiding allergic molecules

• In-vivo efficacy evaluation of drug molecules helps in avoiding ineffective drug formulations that saves the time of the clinician as well as that of the patient.

• Clinicians can relax and focus on much higher and finer medical issues and follow-up measures

• Reduced morbidity that increases clinician’s rapport

• Clinic-guided procurement mode 

• Benefits to the hospital

• More drugs turn-over with lesser budget

• Medicines at a competitive price

• Nil wastage of drugs due to expiry / idling stock due to  Clinic-guided procurement mode

• Reduced hospital stay that increases hospital rapport

• Minimized local panic purchase

• Zero stock of  ineffective and irrational formulations

• Benefits to the patient

• Availability and accessibility of all required drugs

• Minimum hospitalization as the system facilitates case specific well-judged pin pointed prescription that reduces manpower loss

• Counseling service by clinical pharmacists to each patient on medication regimen

• Minimizes medication trials

• Boosts patient confidence, improves trust in healthcare system, improve drug adherence

• Improved overall quality-of-life of patient and family

• Manpower and other infrastructure required:

• True, any new hither to non existing professional system warrants additional manpower and updating the skill and knowledge of the existing manpower.

• The existing pharmacy manpower would be fully utilized with due recognition and empowerment. 👉👉👉Besides, we need to employ certain specialized category of Pharmacist and post them with due empowerment to make them serve with responsibility and accountability.

• 👉Here I propose the following organogram for establishing Pharmacare Department in each Hospital: Drug Logistics Management (DLM) headed by a Chief Drugs Logistic Pharmacist (CDLP) and Supportive Clinical Pharmacy Service (SCPS) headed by a Chief Clinical Pharmacist

• Every hospital with a minimum of 100 beds should have a full-fledged Pharmacare department.

• The Pharmacy staff structure for a 100 bed hospital should be:

• Drugs Logistic stream:

• Chief Drugs Logistic Pharmacist (CDLP) - {Reporting to Medical Director of the hospital}

• Chief Pharmacist 1

• Pharmacists 8 ( 2*2 for main and sub stores & 2 + 2 for dispensing)

• One Clerical executive to assist CDLP as secretarial support)

• Supportive Clinical Pharmacy Service:

• Chief Clinical Pharmacist  1 {Reporting to Medical Director of the hospital}

• Unit Clinical Pharmacist  One for each Unit.

• Chief Pharmacist – One for each Unit to assist Unit Clinical Pharmacist

•  Pharmacist – One for each unit.

• Three Secretarial executive to Chief Clinical Pharmacist

• NB: All Chief pharmacists and Pharmacists are interchangeable between Logistic and clinical pharmacy streams.

• Well, I have tried to inject the Healthcare system with a professional PharmaCare management keeping all aspects of hospital management in view out of my experience, observations, prevailing strength and weakness of the hospitals, their existing managerial burden, freedom required to clinicians and administrators and to the pharmacists to serve with due accountability for patients safety..

• I wish this will materialize.

• <<<>>>

•

Pharmacists cannot open clinics to diagnose disease & prescribe medicine; clarifies PCI

Clearing the doubts on pharmacists can open pharma clinics to treat common disease and prescribe medicine, Pharmacy Council of India (PCI) has recently notified that the pharmacists cannot open clinics to diagnose the disease and prescribe the medicines.

PCI has clarified that there is no provision in the Pharmacy Practice Regulations (PPR), 2015 which allows the pharmacists to practice medicine. Under the said Regulations, the registered pharmacist is required to dispense medicines on the prescription of a registered medical practitioner and can counsel the patient or care giver on medicine to enhance or optimise drug therapy.

The elements of patient counselling includes, name and description of the drugs;the dosage form, dose, route of administration, and duration of drug therapy; intended use of the drug and expected action; special directions and precautions for the drug; common severe side effects or adverse effects or interactions and therapeutic contraindications that may be encountered, including their avoidance, and the action required if they occur; techniques for self monitoring drug therapy; proper storage of the drugs; prescription refill information; action to be taken in the event of a missed dose and to ensure rational use of drugs.

Dr. B Suresh, president of PCI informed that there are few groups of pharmacists who are claiming that they are doctors and there are various messages being circulated on social media, e-mails, WhatsApp etc. that pharmacists are empowered under PPR, 2015 to open pharma clinics to diagnose the disease and prescribe medicines.

We would like to clarify that there are no such provision under PPR, 2015 which allows pharmacists to diagnose and prescribe medicine. PPR, 2015 only allows the pharmacists to practice pharmacy and not medicine, they can counsel the patient or care giver and dispense medicines on the prescription of a registered medical practitioner but cannot prescribe medicines to the patients

He further adds, “Under no circumstances, the registered pharmacist is empowered under the Pharmacy Act, 1948 and PPR, 2015 to practice medicines or open clinics to provide medical care.

BUT, My query is : Can a registered pharmacist(PHARM D) approved with Clinical Pharmacy Council give PHARMA CARE in his PHARMACY? Services like prior authorization and refill authorization for prescription drugs is permitted?

PHARMACEUTICAL ERRORS

Pharmceutical Errors are different from Medical Errors.

Manufacturing Errors
Compounding Errors 

Dispensing Errors

Storage Errors

Accounting Errors
Clerical errors
Inventory errors
computer entry errors
Data entry in sheet errors
Pharmceutical Calculation Errors

Pharmaceutical Formulation Errors (Research & Development Errors)

Pharmaceutical Analysis Errors

Method of administration Errors

Drug Dose Titration Errors

Adverse Drug Reaction Reporting Errors (Pharmacovigilance Errors)

Drug Drug Interaction Reporting Errors

Ward Round Errors

prescription drug

A prescription drug (also prescription medication or prescription medicine) is a pharmaceutical drug that legally requires a medical prescription to be dispensed. In contrast, over-the-counter drugs can be obtained without a prescription. The reason for this difference in substance control is the potential scope of misuse, from drug abuse to practicing medicine without a license and without sufficient education. Different jurisdictions have different definitions of what constitutes a prescription drug.

"Rx" (℞) is often used as a short form for prescription drug in North America- a contraction of the Latin word "recipe" (an imperative form of "recipere") meaning "take". Prescription drugs are often dispensed together with a monograph (in Europe, a Patient Information Leaflet or PIL) that gives detailed information about the drug.

The use of prescription drugs has been increasing since the 1960s. In the U.S., 88% of older adults (62–85 years) use at least 1 prescription drug, while 36% take at least 5 prescription medicines concurrently

Regulation

Australia

In Australia, the Standard for the Uniform Scheduling of Medicines and Poisons (SUSMP) governs the manufacture and supply of drugs with several categories:

• Schedule 1 – Defunct
• Schedule 2 – Pharmacy Medicine
• Schedule 3 – Pharmacist-Only Medicine
• Schedule 4 – Prescription-Only Medicine/Prescription Animal Remedy
• Schedule 5 – Caution
• Schedule 6 – Poison
• Schedule 7 – Dangerous Poison
• Schedule 8 – Controlled Drug (Possession without authority illegal)
• Schedule 9 – Prohibited Substance
• Unscheduled Substances

Like in the UK, the patient visits a health practitioner, (doctor, nurse, dentist, podiatrist, etc.,), who may prescribe the drug.

Many prescriptions issued by health practitioners in Australia are covered by the Pharmaceutical Benefits Scheme, a scheme that provides subsidised prescription drugs to residents of Australia to ensure that all Australians have affordable and reliable access to a wide range of necessary medicines. When purchasing a drug under the PBS, the consumer pays no more than the patient co-payment contribution, which, as of January 1, 2017, is A$38.80 for general patients. Those covered by government entitlements (low-income earners, welfare recipients, Health Care Card holders, etc.) and or under the Repatriation Pharmaceutical Benefits Scheme (RPBS) have a reduced co-payment, which is $6.30 in 2017. The co-payments are compulsory and cannot be discounted by pharmacies under any circumstances.

Private prescriptions are issued for medicines that are not covered on the PBS or are used off-label, for indications other than those covered by the PBS. The patient pays the pharmacy for medicines that are privately prescribed.

United Kingdom

In the United Kingdom, the Medicines Act 1968 and the Prescription Only Medicines (Human Use) Order 1997 contain regulations that cover the supply of sale, use, prescribing and production of medicines. There are three categories of medicine:

• Prescription-only medicines (POM), which may be sold by a pharmacist if they are prescribed by a prescriber
• Pharmacy medicines (P), which may be sold by a pharmacist without a prescription
• General sales list (GSL) medicines, which may be sold without a prescription in any shop

The possession of a prescription-only medicine without a prescription is legal unless it is covered by the Misuse of Drugs Act 1971.

A patient visits a medical practitioner or dentist, who may prescribe drugs and certain other medical items, such as blood glucose-testing equipment for diabetics. Also, suitably-qualified and experienced nurses and pharmacists may be independent prescribers. Both may prescribe all POMs, but pharmacists may not prescribe Schedule 1 controlled drugs. District nurses and health visitors have had limited prescribing rights since the mid-1990s; until then, prescriptions for dressings and simple medicines had to be signed by a doctor. Once issued, a prescription is taken by the patient to a pharmacy, which dispenses the medicine.

Most prescriptions are NHS prescriptions, subject to a standard charge that is unrelated to what is dispensed. The NHS prescription fee was increased to £8.60 per item in Englandon 1 April 2017; prescriptions are free of charge if prescribed and dispensed in Scotland,Wales and Northern Ireland, and for some patients in England, such as inpatients, children, those over 60s or with certain medical conditions, and claimants of certain benefits.The pharmacy charges the NHS the actual cost of the medicine, which may vary from a few pence to hundreds of pounds. A patient can consolidate prescription charges by using a prescription payment certificate (informally a "season ticket"), effectively capping costs at £29.10 per quarter or £104.00 per year.

Outside the NHS, private prescriptions are issued by private medical practitioner and sometimes under the NHS for medicines that are not covered by the NHS. NHS supply beyond three months' worth is not covered and must be purchased privately. A patient pays the pharmacy the normal price for medicine prescribed outside the NHS.

Survey results published by Ipsos MORI in 2008 found that around 800,000 people in England were not collecting prescriptions or getting them dispensed because of the cost, the same as in 2001.

United States

Regulation of therapeutic goods in the United States
Prescription drugs Over-the-counter drugs
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v t e

In the United States, the Federal Food, Drug, and Cosmetic Act defines what substances require a prescription for them to be dispensed by a pharmacy. The federal government authorizes physicians, psychiatrists, physician assistants, nurse practitioners and other advanced practice nurses, veterinarians, dentists, and optometrists to prescribe any controlled substance. They are then issued unique Drug Enforcement Act numbers; many other mental and physical health technicians, including basic-level registered nurses, medical assistants, emergency medical technicians, most psychologists, and social workers, for example, do not have the authority to prescribe any controlled substance.

The Controlled Substances Act (CSA) was enacted into law by the US Congress of the United States in 1970. It is the federal drug law that regulates manufacture, importation, possession, use, and distribution of certain substances. The legislation classes substances into five schedules, with varying qualifications for each schedule.

The safety and the effectiveness of prescription drugs in the US are regulated by the 1987 Prescription Drug Marketing Act (PDMA). The Food and Drug Administration (FDA) is charged with implementing the law.

Misuse or abuse of prescription drugs can lead to adverse drug events, including those due to dangerous drug interactions. According to one study, as many as 15% of older American adults are at risk of potential major interactions between drugs.

The package insert for a prescription drug contains information about the intended effect of the drug and how it works in the body. It also contains information about side effects, how a patient should take the drug, and cautions for its use, including warnings about allergies.

As a general rule, over-the-counter drugs (OTC) are used to treat a condition that does not need care from a healthcare professional if have been proven to meet higher safety standards for self-medication by patients. Often, a lower strength of a drug will be approved for OTC use, but higher strengths require a prescription to be obtained; a notable case is ibuprofen, which has been widely available as an OTC pain killer since the mid-1980s, but it is available by prescription in doses up to four times the OTC dose for severe pain that is not adequately controlled by the OTC strength.

Herbal preparations, amino acids, vitamins, minerals, and other food supplements are regulated by the FDA as dietary supplements. Because specific health claims cannot be made, the consumer must make informed decisions when purchasing such products.

By law, American pharmacies operated by "membership clubs" such as Costco and Sam's Club must allow non-members to use their pharmacy services and may not charge more for these services than they charge as their members.

Physicians may legally prescribe drugs for uses other than those specified in the FDA approval, known as off-label use. Drug companies, however, are prohibited from marketing their drugs for off-label uses.

Large US retailers that operate pharmacies and pharmacy chains use inexpensive generic drugs as a way to attract customers into stores. Several chains, including Walmart, Kroger (including subsidiaries such as Dillons), Target, and others, offer $4 monthly prescriptions on select generic drugs as a customer draw.^[16] Publix Supermarkets, which has pharmacies in many of their stores, offers free prescriptions on a few older but still effective medications to their customers. The maximum supply is for 30 days.

Many prescription drugs are commonly abused, particularly those marketed as analgesics, including fentanyl (Duragesic), hydrocodone (Vicodin), oxycodone (OxyContin), oxymorphone (Opana), propoxyphene (Darvon), hydromorphone (Dilaudid), meperidine (Demerol), and diphenoxylate (Lomotil).

Prescription painkillers have been found to be extremely addictive, and unintentional poisoning deaths in the United States have skyrocketed since the 1990s. Prescriber education guidelines as well as patient education, prescription drug monitoring programs and regulation of pain clinics are regulatory tactics which have been used to curtail opioid use and misuse.

Expiration date

The expiration date, required in several countries, specifies the date up to which the manufacturer guarantees the full potency and safety of a drug. In the United States, expiration dates are determined by regulations established by the FDA. The FDA advises consumers not to use products after their expiration dates.

A study conducted by the U.S. Food and Drug Administration covered over 100 drugs, prescription and over-the-counter. The res Joel Davis, a former FDA expiration-date compliance chief, said that with a handful of exceptions—notably nitroglycerin, insulin, some liquid antibiotics; outdated tetracyclines can cause Fanconi syndrome—most expired drugs are probably effective.

The American Medical Association (AMA) issued a report and statement on Pharmaceutical Expiration Dates. The Harvard Medical School Family Health Guide notes that, with rare exceptions, "it's true the effectiveness of a drug may decrease over time, but much of the original potency still remains even a decade after the expiration date".

The expiration date is the final day that the manufacturer guarantees the full potency and safety of a medication. Drug expiration dates exist on most medication labels, including prescription, over-the-counter (OTC) and dietary (herbal) supplements. U.S. pharmaceutical manufacturers are required by law to place expiration dates on prescription products prior to marketing. For legal and liability reasons, manufacturers will not make recommendations about the stability of drugs past the original expiration date.

Cost

Prices for prescription drugs vary widely around the world. Prescription costs for biosimilar and generic drugs are usually less than brand names, but the cost is different from one pharmacy to another.

Prescription drug prices including generic prices are rising faster than the average rate of inflation. To subsidize prescription drug costs, some patients have decided to buy medicine online.

Environment

Traces of prescription drugs — including antibiotics, anti-convulsants, mood stabilizers and sex hormones — have been detected in drinking water.

Premedication

Premedication is using medication before some other therapy (usually surgery or chemotherapy) to prepare for that forthcoming therapy. Typical examples include premedicating with a sedative or analgesic before surgery; using prophylactic (preventive) antibiotics before surgery; and using antiemetics or antihistamines before chemotherapy.

Premedication before chemotherapy for cancer often consists of drug regimens (usually 2 or more drugs, e.g. dexamethasone, diphenhydramine and omeprazole) given to a patient minutes to hours before the chemotherapy to avert side effects or hypersensitivity reactions (i.e. allergic reactions).

Melatonin has been found to be effective as a premedication in both adults and children due to its pharmacological properties of hypnotic, antinociceptive and anticonvulsant which produce effective anxiolosis and sedation. Unlike midazolam melatonin does not impair psychomotor skills or adversely affect the quality of recovery. It has a faster recovery time compared to midazolam and has a reduced incidence of post-operative excitement and results in a reduction in dose required of propofol and thiopental.

Midazolam is effective in children in reducing anxiety associated with separation from parents and induction of anesthesia. Sufentanil is also sometimes used as a premedication. Clonidine is becoming increasingly popular as a premedication for children. One drawback of clonidine is that it can take up to 45 minutes to take full effect. In children, clonidine has been found to be equal to and possibly superior to benzodiazepines as a premedication. It has a more favourable side effect profile. It also reduces the need for an inductionagent. It improves post-operative pain relief, is better at inducing sedation at induction, reduces agitated emergence, reduces shivering and post-operative nausea and vomiting and reduces post-operative delirium associated with sevoflurane anaesthesia. Benzodiazepines such as midazolam are more commonly used due largely to a lack of a marketing effort by the pharmaceutical companies. As a result, clonidine is becoming increasingly popular with anesthesiologists  . Dexmedetomidine and atypical antipsychotic agents are other premedications which are used particularly in very uncooperative children.

Non-drug interventions for children include playing relaxing music, massages, reducing noise and controlling light to maintain the sleep wake cycle. Other non-pharmacological options for children who refuse or cannot tolerate premedication include clown doctors; low sensory stimulation and hand-held video games may also help reduce anxiety during induction of general anesthesia.

Patient Satisfaction In Healthcare

Days are over when a patient walking inside a hospital only care about the doctor giving him right treatment for his diseases. 

Today's patient is our consumer who unlike any other service industry now expect the same type of customer delight from a hospital in addition to the treatment.

He wants the full value for his money, in terms of having a good doctor, friendly hospital staff, hospital ambiance, his comforts etc. 

They judge the hospital on various parameters other than doctor and there view about the hospital can make or break the hospital image. 

But why all of a sudden the whole industry is more worried about patient satisfaction ??? 

The reason is simple : One happy customer will get 2 more customer, but one unhappy customer will cost 10 other customers. 

But what exactly do patients want, besides having their conditions treated???

According to a survey, patients valued the interpersonal skills of their doctors as much as if not more than their technical skills.

So how exactly can we ensure that the patients are satisfied ??? 

This can be a tricky question, the reason being that no two person think alike, I might feel annoyed if a Patient Relation executive keep asking me the details to fill form and try to understand my socio-economic status n all , but on other hand you might think that as a patient care from his side to understand what exactly is the requirement of the patient. 

So aiming a 100% patient satisfaction is not a practical target to achieve , but all the organisation should try to achieve the maximum which they are capable of. 

A very easy method of ensuring patient satisfaction is  SATISFIED & MOTIVATED STAFF, when your staff is happy with the management and are motivated towards work then be assured that 70% of your work is done. Programs need to be in place to help physicians and nurses improve their bedside manners. Secondly, staff and providers need to be fully engaged, and communication is the key here. Patients would like to be acknowledged; simply greeting them as you enter their room sets the right tone for rest of your interaction with them. Next, introduce yourself. Give them your name and your specialty. This is then followed by explaining to them, step by step, in accessible language, what is going to happen and how the procedure is going to last. Finally, spend sometime answering their questions, and thank the patient before leaving their room.

It would seem like patient satisfaction is intricately linked to patient outcomes. Patients who are more satisfied are more likely to adhere to treatment plans and maintain their relationships with their healthcare providers. This essentially translates to lower readmission rates, reduced lengths of stay, and increased savings for the hospitals.

What exactly is patient satisfaction:

Many hospitals think patient satisfaction is all about keeping patients happy; they are missing the point, because patient satisfaction should also be about a hospital’s philosophy about delivery of care, and that involve the complete team of hospital from front office , doctors, nurses, billing, diagnostics, housekeeping etc.

Unfortunately, doctors spend more time improving their medical knowledge than improving their approach to patient care.

What does a hospital achieve from Patient Satisfaction :

• Greater profitability.
• Improved patient retention and patient loyalty.
• Increased patient referrals.
• Improved compliance.
• Improved productivity.
• Better staff morale.
• Reduced staff turnover.
• Improved collections.
• Greater efficiency.
• Reduced risk of malpractice suit.
• Personal and professional fulfillment.
• Name and fame to the organisation

So to sum up all the above things we can just say that A Happy Patient is Key for Success for the Hospital.

There are simple solutions to improve patient satisfaction scores. All a practice needs to do is to listen and take heed of what their patients have to say.

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